Haut and his associates found that on top of the 11 percent overall higher risk of death among such patients, some types of trauma patients faced an even worse prognosis when given a pre-hospital IV.
For example, patients whose injuries were due to a stabbing or shooting were found to face a 25 percent elevated risk of death if they were given a pre-hospital IV, relative to those who weren't. And those with severe head injuries and/or those who ultimately underwent emergency surgery in the hospital appeared to face a 35 percent greater risk of death if administered a pre-transport IV.
"I certainly don't think that this study is the final answer to the question about pre-hospital fluids," acknowledged Haut. "But I do think that we can see here that it's not always beneficial, and may actually be harmful."
Wally Ghurabi, emergency department director at the Santa Monica-UCLA Medical Center in Santa Monica, Calif., described the finding as "fascinating."
"On the one hand, this is really a question of plumbing, because you want to try and keep the patient's condition status quo until you get him in to the hospital. But if the patient has lost a liter of blood and you immediately water it down with an IV then you raise the patient's blood pressure, and that can change the patient's condition before you get him in," Ghurabi explained.
"So, then it all depends on the pre-hospital timing situation. Are you next door to a hospital or three hours away? Are you in New York City, one block away from NYU? That's one thing. But if you're in a rural area very far away, that's another. So there's potential here for some common sense to factor into the decision-making process," he added.
"And this study opens the door for us to talk about these issues," Ghurabi continued. "Right now, we have very specific pre-hospital criteria that we currently teach paramedics. And what we teach is to do t
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